what is the group benefits program?

FROM INFORMATION TO ACTION

State Worksite Wellness Conference Ann S. Fuelberg, Employees Retirement System of Texas

October 12-13, 2009

2 2009 State Worksite Wellness Conference

WHAT IS THEGROUP BENEFITS PROGRAM?


• One advantage of joining a large self-funded plan like the GBP is that each member of the group shares the risk for the plan’s health claims equally.

• Managing health care effectively for the entire “group” is how ERS can offer employees and retirees a range of high quality, affordable benefits at a uniform rate.GBP = “GROUP”

Benefits Program527,792 Participants

The GBP covers 1 in 46 Texans through its health plans


HOW MUCH DOES THE GBP COST AND WHO PAYS FOR IT?


The State of Texas Pays Most of the Cost59 cents of every dollar

MemberContributions

13¢

Member Copays and Coinsurance

19¢

State Contribution59¢

Other Sources(such as the

Reserve Fund) 9¢

Potential Funding Gap Based on Emerging 9% Cost Trend

Contributions will pay 6.5% of the increase

Contributions will pay 6.8% of the increase

Smaller reserve fund can only cover $97 million of increased cost

Reserve fund may pay $179 millionof the increased cost Potential funding gap is $154 million

or 6.5% of the total plan expenses



WHAT DRIVES COSTS IN THE GBP?

COST DRIVER: Aging healthy members adds 1.9% to the annual health cost trend


Under 50

50and over 50

and overUnder 50

COST DRIVER: Hospital expenditures are rising faster than any other HealthSelect category


(HealthSelect expenditures over time, as a percentage of total plan costs)

HealthSelect paid the most for these 5 types of hospital inpatient stays (Active and Retirees)


Source: Major Diagnostic Category Summary for All Claims, HealthSelect Annual Statistical Report, 2008

Mill

ions

Source: Texas Employees GBP FY2009 HealthSelect PDP Experience, Rudd & Wisdom

COST DRIVER: Prescription drug trend - GBP spends more than $1.5 million/every day on drugs

112009 State Worksite Wellness Conference

Rank Drug Condition

1 Nexium Digestive Disorder

2 Lipitor High Cholesterol

3 Enbrel Musculoskeletal

4 Plavix Heart Disease

5 Humira Musculoskeletal

6 Actos Diabetes

7 Advair Diskus Asthma/Bronchitis/Allergies

8 Cymbalta Depression/Sleep Disorder

9 Crestor High Cholesterol

10 Effexor Depression/Sleep Disorder

Rank Drug Condition

11 Lantus Diabetes

12 Singulair Asthma/Bronchitis/Allergies

13 Diovan High Blood Pressure

14 Celebrex Musculoskeletal

15 Valtrex Neurological Disorders

16 Lexapro Depression/Sleep Disorder

17 Provigil Depression/Sleep Disorder

18 Lyrica Musculoskeletal

19 Tricor High Cholesterol

20 Copaxone Musculoskeletal

COST DRIVER: Name brand drugs increase costs


The GBP and its members could save $5.3 million/year if four recently approved generic drugs were used rather than the brand-name drugs


Source: BlueCross BlueShield Texas, Expense Report, FY2009

COST DRIVER: Percent of members suffering from top 5 chronic conditions

18%

12%

6%

3%

0%HypertensionDiabetes and

High CholesterolAsthma Degenerative

Back DisorderHeart

Disease

15%16%

5%4%

2%Perc

ent o

f Hea

lthSe

lect

Par

ticip

ants

with

con

ditio

n

15%

9%


WHAT ARE THE CURRENT WELLNESS OFFERINGS WITH THE GBP?

GBP Wellness Benefits for State Employees


GBP participants have access to: • Health Risk Assessments• Coaching programs for tobacco cessation and weight loss• Disease management programs for those with chronic

conditions• Mother and baby programs for pre- and post-natal care• A 24-hour Nurseline• Personal Health Manager• Discounts to gyms, eyewear, etc.• Flu Shots and Health Screening Reminders• Youth Fitness ProgramHealthSelect participants can earn up to $600 per year for using

the Personal Health Manager.


HIPAA ensures that your personal health information is always protected•Personal health information will not be released to anyone (including your employer ) without your written consent. • HRA results may not be used to discriminate against you when applying for health insurance or for another job if you leave state employment. •HRA results are only used for outreach for Blue Care Connection® programs, which are designed to assist you with managing chronic conditions or helping participants achieve a healthy lifestyle.

Your personal health information is always protected

Help us promote wellness participationStatewide participation rates are very low


Program # of ParticipantsHealth Risk Assessment 6,555

This is 1.4% of total HealthSelect membership of 468,977 (as of 08/31/2009)

Disease Management 8,361Nurseline 4,599Weight Management 1,531Tobacco Management 40


MOVING AGENCIES INTO ACTION:RESOURCES TO HELP YOU

PROMOTE WELLNESS


NEW online at ERS.STATE.TX.US•Now you can go to the ERS website to analyze HealthSelect data specific to 8 regions of the state

•Total number of active state employees and their dependents per region

Regional Health Indicators Map


View the top conditions in your region•Link to BCBS Wellness presentations about that condition

•Coming soon are participation rates in disease management programs for each region

Regional Health Indicators Map


BlueResource materials

Click here:New HealthSelect Wellness Icon



New HealthSelect Wellness website


Regional HealthIndicator MapShows you top

chronic conditions for

your region with links to…

Wellness Presentations

Aimed at Top 5

Chronic Conditions ready

for you to use

New HealthSelect

Wellness Logofor you to add to your website that

takes your employees directly to…

Blue Care Connectionoffering a full

suite of wellness and disease prevention programs

Resources for you and your employees

Thank You

www.ers.state.tx.us


what is the group benefits program?

Documents

gbp cost

annual health cost trend

health plans

chart data range

lower right corner of

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plans health claims

range of high quality